TOMLINSON AND ASSOCIATES, INC

TOMLINSON & ASSOCIATES
PO Box 108, Boise, ID 83701 Phone (208) 343-6438 FAX (208) 338-1777
RENTAL APPLICATION
Please complete the attached Application for Housing. Be sure to fill out all the
areas on the application in detail and sign both areas on the back page.
Incomplete applications will not be processed. When you return the
application you will need to include a $21.50 money order per adult for the
screening. Additional information needed once you pass the background and
start the paperwork is listed below. Thanks!
Items listed below are NOT required until the day of lease signing:
Driver’s License (Photo ID)
Social Security Cards or proof of SS# for all members
Birth Certificates
Divorce Decrees
Tax Returns for the most recent tax year
Please be aware that the utility companies charge a deposit to switch the
utilities over into your name. This will need to be done BEFORE you move
into your residence. Failure to be able to switch utilities will make you
ineligible to live here.
RESIDENTIAL
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
PO Box 108, Boise, ID 83701 Phone (208) 343-6438 FAX (208) 338-1777
SOLICITUD DE ARRENDAMIENTO
Por favor, complete la solicitud adjunta para la vivienda.
Asegúrese de completar todas las áreas de la solicitud en
detalle y firmar ambas áreas en la última página. Se debe
completar el lado de inglés. No se procesarán solicitudes
incompletas. Al devolver la solicitud deberá incluir un
giro postal (money order) de $ 21.50 por adulto por la
revisión. Abajo aparece la información adicional necesaria
una vez que pase la revisión y empiece el papeleo.
¡Gracias!
Los puntos que aparecen a continuación NO son necesarios
hasta el día de la firma del contrato de arrendamiento:
Licencia de conducir (Identificación con foto)
Tarjetas de Seguro Social o prueba de #SS para todos los
integrantes Certificados de nacimiento
Acta de divorcio
Declaraciones de impuestos para el año fiscal más reciente
Por favor, tenga en cuenta que las empresas de servicios
públicos cobran un depósito por cambiar los servicios a su
nombre. Esto tendrá que hacerse ANTES de mudarse a su
residencia. El no poder cambiar los servicios públicos lo
hará inelegible para vivir aquí.
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
RESIDENCIAL
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
Date Received:
APPLICATION FOR HOUSING
Time Received:
Mgr. Initials:
Date Received:
Name of Property
________________
#
of
Bedrooms
Requested
Time Received:
Mgr. Initials:
Applicant Household Name (Last Name)
Phone
#
Please provide the following household member information:
Last Name
First Name
Relationship
Birthdate
mo/day/yr
Social
Security #
Full-time
Student*
Yes or No
Head
*Full-time student is defined as persons who have been, are, or will be attending school at an educational institution
with regular faculty and students during five months of the current calendar year (including elementary, junior high and high
school students).
A.
Have you or anyone listed on this application ever lived in a Tomlinson & Associates property?
Yes___ No ___ If YES, Who and Where ______________________________________________
B.
Does anyone live with you or do you plan to have anyone living with you in the next 12
months who is not listed above?
Yes No
If YES, explain
C.
Have you or anyone listed on this application ever been evicted from public housing or any
other Federal housing program?
Yes No
If YES, Who
Where
When
Describe Reason(s)
D.
Have you or anyone listed on this application ever been evicted from other housing?
Yes
No
If YES, who _______________________
E.
Have you or anyone listed on this application ever been convicted of a felony?
Yes
No
If YES, who _______________________
F.
Are you or anyone listed on this application currently using illegal drugs?
Yes
No
G.
Have you or anyone listed on this application ever been convicted of sale, distribution, or
possession of illegal drugs?
Yes
No
If YES, who______________________
H.
Are you or anyone listed on this application applying for status as handicapped or disabled?
Yes
No
If YES, who______________________
I.
Do you or anyone on the application need a wheelchair or handicapped accessible unit?
Yes___ No ___
J. Are you or anyone on this application currently living in Subsidized Housing?
Yes___ No___ If YES, Where ___________________________________
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
SOLICITUD DE VIVIENDA
Nombre de la propiedad
# de habitaciones solicitadas ________________
Nombre de solicitante de vivienda (Apellido)
#teléfono
Por favor proporcione la siguiente información de los integrantes del hogar:
Relación
Apellido
Nombre
Fecha de
nacimiento
mes/día/año
# Seguro social
Estudiante
tiempo
completo*
Sí o No
Cabeza del
hogar
* Estudiante de tiempo completo se define como la persona que ha estado, está o asistirá a la escuela en una institución educativa
con profesorado y estudiantes regulares durante cinco meses del año calendario actual (incluyendo estudiantes de primaria,
secundaria y preparatoria).
A.
¿Usted o alguna persona mencionada en esta solicitud ha vivido alguna vez en una propiedad de Tomlinson & Associates?
Sí___No___ En caso afirmativo, quién y dónde ______________________________________________
B.
¿Alguien vive con usted o planea que alguien viva con usted en los próximos 12 meses y que no está en la lista
anterior?
Sí___ No ___ En caso afirmativo, explique
C.
¿Usted o alguna persona mencionada en esta solicitud alguna vez ha sido desalojado de una vivienda pública o
de cualquier otro programa federal de vivienda?
Sí___ No ___ En caso afirmativo, quién
dónde
cuándo
Describa
la(s) razón(es)
___
D.
¿Usted o alguna persona mencionada en esta solicitud alguna vez ha sido expulsado de otra vivienda?
Sí___ No ___ En caso afirmativo, quién _______________________
E.
grave?
¿Usted o alguna persona mencionada en esta solicitud ha sido condenado alguna vez
por un
delito
Sí___ No ___ En caso afirmativo, quién _______________________
F.
¿Está usted o alguna persona mencionada en esta solicitud actualmente usando
Sí___ No ___
drogas
ilegales?
G.
¿Usted o alguna persona mencionada en esta solicitud ha sido condenado por la venta, distribución o posesión
de drogas ilegales?
Sí___ No ___ En caso afirmativo, quién______________________
H.
¿Está usted o alguna persona mencionada en esta solicitud aplicando para la condición de
minusválido o discapacitado?
Sí___ No ___ En caso afirmativo, quién______________________
I.
¿Usted o alguna persona mencionada en la solicitud necesita una silla de ruedas o unidad de acceso para incapacitados?
Sí___ No ___
J.
K.
¿Está usted o alguna persona en esta solicitud viviendo actualmente en una vivienda subsidiada?
Sí___ No___ En caso afirmativo, dónde ___________________________________
Will you take an apartment when one is available?
Yes___ No___
L. Briefly describe your reasons for applying _______________________________________________
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
M. How did you hear about this housing? __________________________________________________
N. Are you subject to the Service Relief Act?
Yes___ No___
O. Are you or anyone on this application a member of the Armed Forces?
Yes___ No___
P. Have you or anyone on this application in the previous 12 months been, currently are, or going to be
in the next 12 months a Part-Time or Full-Time student?
Yes___ No___ If yes, who and when___________________________________________________
_______________________________________________________________________________________
Please list all residences in the last three(3) years:
Name of Present Landlord
Landlord's Address
City
State
Length of Residency
Monthly Housing Cost (including utilities)$
Check which applies: Own______ Rent_______
Telephone
Zip
Name of Previous Landlord
Landlord's Address
City
State
Length of Residency
Monthly Housing Cost (including utilities) $
Check which applies: Own______ Rent_______
Telephone
Zip
Name of Previous Landlord
Landlord's Address
City
State
Length of Residency
Monthly Housing Cost (including utilities) $
Check which applies: Own______ Rent_______
Telephone
Zip
Personal References:
(2 persons not related to you, whom you have known at least one year)
Name
Name
Address
Address
PETS: Do you own any pets? YES
If YES, Describe
Automobile:
Make
Make
Make
Color
Color
Color
Telephone
Telephone
NO
Model
Model
Model
Year
Year
Year
License #
License #
License #
In Case of Emergency, Notify:
Name
Name
Address
Address
Telephone
Telephone
Please list hobbies, activities and interests you might want to share with other residents:
K. ¿Tomará un apartamento cuando haya uno disponible?
Sí___ No___
L. Describa brevemente sus tazones para hacer la solicitud _________________________________________
M. ¿Cómo se enteró de esta vivienda? __________________________________________________
N. ¿Está usted sujeto a la Ley de Alivio de servicio?
Sí___ No___
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
O. ¿Es usted o alguna persona en esta solicitud integrante de las Fuerzas Armadas?
Sí___ No___
P. ¿Usted o alguien en esta solicitud en los 12 meses previos ha sido, es en la actualidad, o va a ser en
los próximos 12 meses un estudiante de medio tiempo o de tiempo completo?
Sí___No___ En caso afirmativo, quién y cuándo________________________________________________
_______________________________________________________________________________________
Por favor, enumere todas las viviendas en los últimos tres (3) años:
Dirección actual
Nombre del propietario
# teléfono
Dirección del propietario
Ciudad
Estado
Código postal
Tiempo de residencia
Costo mensual de la vivienda (incluyendo servicios) $
Marque el correspondiente: Propia______ Alquiler_______
Dirección anterior
Nombre del propietario
# teléfono
Dirección del propietario
Ciudad
Estado
Código postal
Tiempo de residencia
Costo mensual de la vivienda (incluyendo servicios) $
Marque el correspondiente: Propia______ Alquiler_______
Dirección anterior
Nombre del propietario
# teléfono
Dirección del propietario
Ciudad
Estado
Código postal
Tiempo de residencia
Costo mensual de la vivienda (incluyendo servicios) $
Marque el correspondiente: Propia______ Alquiler_______
Referencias personales:
(2 personas que no sean familiares, y que conozca desde al menos hace un año)
Nombre
Nombre
Dirección
Dirección
MASCOTAS: ¿Usted tiene alguna mascota? SÍ
En caso afirmativo, Describa
Automóvil:
Marca
Marca
Marca
Color
Color
Color
Teléfono
Teléfono
NO
Modelo
Modelo
Modelo
Año
Año
Año
# licencia
# licencia
# licencia
En caso de emergencia, notifique a:
Nombre
Nombre
Dirección
Dirección
Teléfono
Teléfono
Por favor haga una lista de aficiones, actividades e intereses que posiblemente desee compartir con otros residentes:
ELIGIBILITY OF STUDENTS
Each of the items listed below must be provided at time of application for students:
1. The individual must be of legal contract age under state law.
Copy of a Birth Certificate, or other legal document for proof of age.
2. The individual must have established a household separate from parents or legal guardians
for at least one year prior.
Copy of Lease agreement needs provided.
3. The individual must not be claimed as a dependent by parents or legal guardians pursuant to
IRS regulations.
Copy of Income Tax Returns for one year prior to application needs attached.
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
4.
The individual must obtain a certification of the amount of financial assistance that will be
provided by parents, guardians or others, signed by the individual providing the support.
Copy of Verification can be obtained from Resident Manager.
INDEPENDENT STUDENT REQUIREMENTS:
Definition of an Independent Student is a person classified as an independent student for Title IV aid,
student must meet one or more of the following criteria:
Please mark all that apply:
________ At least 24 years old by December 31st of the award year for which aid is sought.
________ An orphan or a ward of the court through the age of 18.
________ A veteran of the U.S. Armed Forces
________ Have legal dependents other than a spouse (ex. dependent children or an elderly
dependent parent)
________ A graduate or professional student
________ Married
_________________________________________________________________________________________
_
**ONLY COMPLETE IF PROPERTY HAS LIHTC FUNDING**
Full-time student is defined as persons who have been, are, or will be attending school at an
educational institution with regular faculty and students during five months of the current
calendar year (including elementary, junior high and high school students).
If
ALL household members are students as defined above, answer the following questions and
provide supporting documentation (ie: current income tax document):
of
1. Do you receive assistance under Title IV of the Social Security Act?
Yes
No _____
2. Are you enrolled in a job training program receiving assistance under the Job Training
Partnership Act or under other similar Federal, State or local laws?
Yes
No _____
3. Are you a single parent with children AND are you and all your children not dependents
anyone else (as defined under Section 152)?
Yes
No _____
4. Are you married and file a joint income tax return?
Yes
No _____
5. Has anyone listed on the application previously been or currently part of foster care?
Yes_________ No_____
ELIGIBILIDAD DE ESTUDIANTES
Cada uno de los puntos que se enumeran a continuación se deben proporcionar al momento de la solicitud para estudiantes:
1. La persona debe tener edad para hacer un contrato legal bajo la ley estatal.
Copia del acta de nacimiento u otro documento legal como prueba de edad.
2. El individuo debe haber establecido un hogar separado de sus padres o tutores legales durante
al menos un año antes.
Se necesita entregar copia del contrato de arrendamiento.
3. La persona no debe ser reclamada como dependiente por parte de los padres o tutores
legales de conformidad con las regulaciones del IRS.
Se necesita adjuntar copia de la Declaración de Impuestos de un año antes de la solicitud.
4. El individuo debe obtener una certificación de la cantidad de ayuda financiera que será
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
proporcionada por los padres, tutores u otras personas, firmada por la persona que
proporciona el apoyo.
Se puede obtener copia de la verificación del Gerente Residente.
REQUISITOS DEL ESTUDIANTE INDEPENDIENTE:
Definición de un estudiante independiente es una persona clasificada como un estudiante independiente
para la ayuda del Título IV, el estudiante debe cumplir con uno o más de los siguientes criterios:
Por favor marque todo lo que corresponda:
________ Al menos 24 años antes del 31 de diciembre del año de concesión de la ayuda que se
solicita.
________ Huérfano o bajo la tutela de la corte hasta la edad de 18 años.
________ Un veterano de las Fuerzas Armadas de los EE.UU.
________ Tiene dependientes legales además de su cónyuge (por ej. hijos a cargo o un padre
anciano dependiente)
________ Un estudiante de posgrado o profesional
________ Casado
_________________________________________________________________________________________
_
** COMPLETE SÓLO SI LA PROPIEDAD TIENE FINANCIACIÓN LIHTC **
Estudiante a tiempo completo se define como la persona que ha estado, está o asistirá a la escuela en una
institución educativa con el profesorado y estudiantes regulares durante cinco meses del año calendario actual
(incluyendo, estudiantes de primaria, secundaria y preparatoria).
Si TODOS los integrantes del hogar son estudiantes como se define anteriormente, responda a las
siguientes preguntas y proporcione documentación de apoyo (por ejemplo: documento actual de la
declaración de impuestos):
1. ¿Recibe ayuda bajo el Título IV de la Ley del Seguro Social?
Sí
No _____
2. ¿Está inscrito en un programa de capacitación para el trabajo recibiendo asistencia
bajo la Ley de asociación de capacitación para el trabajo o bajo otras leyes federales,
estatales o locales similares?
Sí
No _____
3. ¿Es usted un padre soltero con hijos Y usted y todos sus hijos no son dependientes de
ninguna otra persona (tal como se define en la Sección 152)?
Sí
No _____
4. ¿Está casado y presenta una declaración de impuestos conjunta?
Sí
No _____
5. ¿Alguien que aparezca en la solicitud ha sido previamente o es actualmente parte del
cuidado de crianza?
Sí _________ No_____
List all income anticipated to be received by members of the household who are 18 years of age
or older during the next 12 months.
Family Member
Type of Income
Sources of Income
Address or Contact Person
Family Member
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
Type of Income
Sources of Income
Address or Contact Person
Sources of Income
Address or Contact Person
Sources of Income
Address or Contact Person
Family Member
Type of Income
Family Member
Type of Income
List all assets owned by household members including:
Current Balance of
Account
Account Number and Location
Asset Owner (Household Member)
%Interest Earned
Annually
Checking Accounts
Savings Accounts
Stocks/Bonds/CD's
Real Estate
Pensions/Retirement
Other
Escriba todos los ingresos previstos a percibir por los integrantes del hogar que tengan 18 años
de edad o más durante los próximos 12 meses.
Integrante de la familia
Tipo de ingreso
Fuentes de ingreso
Dirección o persona de contacto
Ingreso anual estimado
Fuentes de ingreso
Dirección o persona de contacto
Ingreso anual estimado
Integrante de la familia
Tipo de ingreso
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
Integrante de la familia
Tipo de ingreso
Fuentes de ingreso
Dirección o persona de contacto
Ingreso anual estimado
Fuentes de ingreso
Dirección o persona de contacto
Ingreso anual estimado
Integrante de la familia
Tipo de ingreso
Enumere todos los activos que les pertenecen a los integrantes del hogar, incluyendo:
Saldo actual de la
cuenta
Número de cuenta y Ubicación
Dueño de Activos (integrante del
hogar)
% intereses
devengados
anualmente
Cuentas Corrientes
Cuentas de Ahorro
Acciones / Bonos / CD 's
Bienes Raíces
Pensiones / Jubilación
Otro
CERTIFICATION
I/We hereby certify that I/We do/will not maintain a separate subsidized rental unit in another location. I/We further
certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for this
apartment. I/We understand that my eligibility for housing will be based on Farmers Home Administration or Section
8 income limits and by Tomlinson and Associates, Inc. selection criteria. I/We certify that all information in this
application is true to the best of my/our knowledge and I/We understand that false statements or information are
punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy.
__________________________________
____________________
Signature
Date
__________________________________
____________________
Signature
Date
__________________________________
____________________
Signature
Date
AUTHORIZATION
I/We do hereby authorize
and its staff or authorized representatives to
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
contact any agencies, local police departments, offices, groups or organizations to obtain and verify any information
or materials which are deemed necessary to complete my/our application for housing in programs
administrated/managed by Tomlinson and Associates, Inc. I further authorize Tomlinson and Associates, Inc. to
verify all information listed on this application.
___________________________________
____________________
Signature
Date
___________________________________
____________________
Signature
Date
___________________________________
____________________
Signature
Date
FAMILY HOUSEHOLD DEMOGRAPHICS
"The information solicited on this application is being requested by the apartment owner in order to assure the Federal
Government, acting through the Farmers Home Administration and/or HUD, that Federal laws prohibiting
discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, marital status, age,
and handicap are complied with. You are not required to furnish this information, but are encouraged to do so. This
information will not be used in evaluating your application or to discriminate against you in any way. However, if you
choose not to furnish it, the owner is required to note the race/national origin and sex of the individual applicants on
the basis of visual observation or surname."
Household Member:
Household Member:
Race:
Race:
Ethnicity:
Ethnicity:
Sex:
Sex:
Household Member:
Household Member:
Household Member:
Household Member:
Race:
Race:
Race:
Race:
Ethnicity:
Ethnicity:
Ethnicity:
Ethnicity:
Sex:
Sex:
Sex:
Sex:
CERTIFICACIÓN
Yo /nosotros certificamos que yo/nosotros/no mantengo/mantenemos una unidad de alquiler subvencionada por
separado en otro lugar. Yo/nosotros certifico/certificamos además que esta será mi/nuestra residencia permanente.
Yo/nosotros entendemos que yo/nosotros debemos pagar un depósito de seguridad por este apartamento.
Yo/nosotros entendemos que mi elegibilidad para la vivienda se basará en la Administración de Farmers Home o en
los límites de ingresos de la Sección 8 y por los criterios de selección de Tomlinson and Associates, Inc.
Yo/nosotros certifico/certificamos que toda la información en esta solicitud es verdadera según mi/nuestro leal
saber y entender y Yo/nosotros entiendo/entendemos que las declaraciones o la información falsa son sancionables
por la ley y conducirán a la cancelación de esta la solicitud o a la terminación del arrendamiento después de la
ocupación.
__________________________________
____________________
Firma
Fecha
__________________________________
____________________
Firma
Fecha
__________________________________
____________________
Firma
Fecha
AUTORIZACIÓN
Yo/nosotros autorizo/autorizamos a
y a su personal o representantes
autorizados para que contacten a cualquier agencia, departamento de policía local, oficina, grupo u organización
para obtener y verificar cualquier información o materiales que se consideren necesarios para completar mi/nuestra
solicitud de vivienda en los programas administrados/manejados por Tomlinson and Associates, Inc. Además
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider
TOMLINSON & ASSOCIATES
autorizo a Tomlinson and Associates, Inc. para verificar toda la información incluida en esta solicitud.
___________________________________
____________________
Firma
Fecha
___________________________________
____________________
Firma
Fecha
___________________________________
____________________
Firma
Fecha
INFORMACIÓN DEMOGRÁFICA DEL HOGAR FAMILIAR
"La información solicitada en esta solicitud la requiere el propietario del apartamento para asegurar al Gobierno
Federal, actuando a través de la Farmers Home Administration y/o HUD, que se está cumpliendo con las leyes
federales que prohíben la discriminación contra los solicitantes inquilinos basándose en la raza, color, nacionalidad,
origen, religión, sexo, estado civil, edad e incapacidad. Usted no está obligado a proporcionar esta información, pero
lo invitamos a hacerlo. Esta información no será utilizada para evaluar su solicitud ni para discriminarlo de ninguna
manera. Sin embargo, si usted elige no proporcionarla, el propietario está obligado a tomar nota de la raza/origen
nacional y sexo de los solicitantes individuales basándose en la observación visual o apellido".
Integrante del hogar:
Integrante del hogar:
Integrante del hogar:
Integrante del hogar:
Integrante del hogar:
Raza:
Raza:
Raza:
Raza:
Raza:
Etnicidad:
Etnicidad:
Etnicidad:
Etnicidad:
Etnicidad:
Sexo:
Sexo:
Sexo:
Sexo:
Sexo:
Integrante del hogar:
Raza:
Etnicidad:
Sexo:
PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant
may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). Violations of these provisions
are cited as violations of 42 USC **408 (a), (6), (7) and (8).
We do not discriminate on the basis of handicapped status in the admission or access to,
or treatment or employment in our federally assisted programs and activities.
Equal Opportunity Employer & Provider